Engorgement/vascular congestion can cause capillary breakage from the 
excessive pressures, breast trauma (as in a car accident or other blow 
to the breast) can cause bleeding into the ducts. Intraductal papillomas 
often cause a LOT of blood, and capillary breakage causes a smaller 
amount of bleeding. Mom won't do any harm continuing to express, and the 
milk won't harm the baby (but baby may spit up more, so prepare her for 
that possibility).

The mom you report on sounds like she has a plugged duct or mastitis, 
which could be the reason for her bleeding. Encourage her to keep the 
milk flowing to reduce the risk of making the inflammation worse by 
creating milk stasis.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com

On 8/5/2013 1:31 PM, Mary Coutts, IBCLC, LLLL wrote:
> I have always thought that blood expressed from the breast without nipple damamge is not a symptom with engorgement or mastitis.  However, I am reading in Breastfeeding, A Guide for the Medical Profession, Lawrence and Lawrence that, "Bloody discharge in pregnancy and lactation is most often caused by vascular engorgement or breast trauma."  Would someone be able to explain this to me?  I received a call from a mom who is breastfeeding and pumping for a one month old.  When she pumped this morning she noticed bright red blood from one breast and immediately stopped pumping.  She mentioned that this breast is tender especially around the areola and she has been feeling achy. She stated she has no nipple pain or nipple damage.  She has not had her pump turned up too high in her opinion. I was thinking intraductal papilloma as a possible cause and during my reading about this, I discovered the above quoted in this reference book. Looking to hear from others much more knowledgeable about this than I.
>
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